Tuesday, June 09, 2015

U of Washington news: Early Start Denver Model Intervention Improves Long-term Outcomes for Children with Autism

Early intervention improves long-term outcomes for children with autism

Early intervention for toddlers with autism spectrum disorder helps improve their intellectual ability and reduces autism symptoms years after originally getting treatment, a new study shows.
The study is the first in more than 20 years to look at long-term outcomes after early intensive autism intervention. The therapy began when children were 18 to 30 months of age and involved therapists and parents working with the toddlers in their homes for more than 15 hours each week for two years.
The study will appear in the July issue of the Journal of the American Academy of Child and Adolescent Psychiatry and is published early online.

"When you intervene early in a child's life, you can make a big difference," said lead author Annette Estes, director of the University of Washington Autism Center. "We hope this translates to a higher quality of life for people with autism spectrum disorder."
The therapy, known as the Early Start Denver Model, or ESDM for short, was designed to promote social and communication skills and learning. The research team found that two years after completing the intervention, children maintained gains in overall intellectual ability and language and showed new areas of progress in reduced autism symptoms.

This type of intervention has been shown to help children with autism, but it hadn't been shown to work with very young children over a longer timescale until now.
These results make the case for autism-specific, one-on-one intervention to begin as soon as autism symptoms emerge, which for many children is before 30 months of age, Estes said.
"This is really important," she said. "This is the kind of evidence that is needed to support effective intervention policies for children with autism, whether it's insurance coverage or state support for early autism intervention."

The researchers studied two groups of young children with autism – the first received community intervention as usual for two years, which was a mix of what was available in the community such as speech therapy and developmental preschool.
The second group received ESDM, which addresses a comprehensive set of goals, is delivered one-on-one in the home, and incorporates parent coaching and parent-delivered intervention with the child. This approach is designed to enhance a child's motivation and follows each child's interests in playing with toys and engaging in fun activities, songs and basic daily routines.

After two years of intensive intervention, children in the ESDM group showed a significantly greater increase in IQ, adaptive functioning, communication and other measures than did the comparison group.
"These findings indicate that children who had received the ESDM earlier in their lives continued to progress well with significantly less treatment than the comparison children received," said co-author Sally J. Rogers, a University of California, Davis professor of psychiatry and co-creator of the Early Start Denver Model intervention.
It was surprising to researchers that two years after the early intervention ended, children who received the one-on-one care saw their autism symptoms reduce further, while children who had participated in community intervention had no overall reduction.
This kind of treatment is important for the well-being of children with autism, but it's also a good idea economically, Estes added.
"People who are better able to communicate, care for themselves and participate in the workforce at greater levels will need less financial support in their lives," she said.

Other co-authors are Jeffrey Munson and Jessica Greenson with the UW Autism Center; Jamie Winter at Weill-Cornell Medical College; and Geraldine Dawson at Duke University.

This research was funded by the National Institutes of Health, the National Institute of Mental Health, the Autism Center of Excellence and the Autism Speaks foundation.

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Why ABA For Autism?

The effectiveness of ABA-based intervention in ASDs has been well documented through 5 decades of research by using single-subject methodology21,25,27,28 and in controlled studies of comprehensive early intensive behavioral intervention programs in university and community settings.29–40 Children who receive early intensive behavioral treatment have been shown to make substantial, sustained gains in IQ, language, academic performance, and adaptive behavior as well as some measures of social behavior, and their outcomes have been significantly better than those of children in control groups.31–4American Academy of Pediatrics, Management of Children with Autism Spectrum Disorders

"We have to look also at environmental factors, and from my point of view, the interaction between the genetic factors and the environmental factors ... It looks like some shared environmental factors play a role in autism, and the study really points toward factors that are early in life that affect the development of the child"
Joachim Hallmayer, MD, associate professor of psychiatry at Stanford University in California

Even Out Environmental and Genetic Autism Research Funding

Right now, about 10 to 20 times more research dollars are spent on studies of the genetic causes of autism than on environmental ones.

We need to even out the funding.

Irva Hertz-Picciotto, UC Davis M.I.N.D. Institute Researcher

My Autism Pledge For Conor

Today I pledge to continue;I Pledge to continue to fight for the availability of effective autism treatments;I Pledge to continue to fight for a real education for autistic children;I Pledge to continue to fight for decent residential care for autistic adults;I Pledge to continue to fight for a cure for autism;I Pledge to continue finding joy in my son but not in the autism disorder that restricts his life;Today, and every day, I Pledge to continue to hope for a better life for Conor and others with autism, through accommodation, care, respect, treatment, and some day, a cure;Today, and every day, I Pledge to continue to fight for the best possible life for Conor, my son with autistic disorder.

Dr. Jon Poling : Blinders Won’t Reduce Autism

"Fortunately, the ‘better diagnosis’ myth has been soundly debunked. ... only a smaller percentage of this staggering rise can be explained by means other than a true increase.

Because purely genetic diseases do not rise precipitously, the corollary to a true autism increase is clear — genes only load the gun and it is the environment that pulls the trigger. Autism is best redefined as an environmental disease with genetic susceptibilities."

We should be investing our research dollars into discovering environmental factors that we can change, not more poorly targeted genetic studies that offer no hope of early intervention. Pesticides, mercury, aluminum, several drugs, dietary factors, infectious agents and yes — vaccines — are all in the research agenda.

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It's NOT About ME

I am the father of two sons one of whom is severely autistic with intellectual disability. I have advocated for autism services for autistic children, students and adults in New Brunswick, Canada and I blog and comment about autism on the world wide web. And I like to walk .. a lot.